Individual provider Active NPI

Jae Wook Dong, M.D.

  • Internal Medicine Physician
  • Suwanee, GA
National Provider Identifier
1689803652
Registry record updated Sep 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
080202 Issued in GA
Practice address
4275 Johns Creek Pkwy Ste a
Suwanee, GA 30024
Phone
(678) 475-1606
Fax
(678) 475-1615
NPI assigned
Jul 10, 2009
Last updated
Sep 5, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125055845 IL
Internal Medicine Physician 207R00000X 40328 IA
Internal Medicine Physician 207R00000X 080202 GA Primary

Addresses

Primary practice location

4275 Johns Creek Pkwy Ste a
Suwanee, GA 30024

Mailing address

1355 Peachtree St NE Ste 1600
Atlanta, GA 30309-3276
Phone (678) 223-7774

Other practice location 1

1340 Upper Hembree Rd Ste A
Roswell, GA 30076-0927
Phone (770) 569-0777

Other practice location 2

3400 Old Milton Pkwy Ste 380
Alpharetta, GA 30005-3707
Phone (678) 987-1485

Other practice location 3

1505 Northside Blvd Ste 2000
Cumming, GA 30041-6205
Phone (770) 781-4010

Other identifiers 1

IdentifierTypeStateIssuer
003204609MMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180619002130 GA Practitioner - Internal Medicine 1658537162 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aga, LLCGroup PAC ID 2365431350, 138 clinicians
Aga Professional Services LLCGroup PAC ID 3870768997, 175 clinicians

Practice addresses (Care Compare)

4275 Johns Creek Pkwy
Suite a
Suwanee, GA 30024-9117
Phone (678) 475-1606

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
74.39 of 100Reported as group
Quality
44.91
Promoting interoperability
98
Improvement activities
40
Cost
71.38

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy67
Upper gastrointestinal (GI) endoscopy for acid reflux113

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125055845ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aga Professional Services, LLC CurrentSince Mar 24, 2018 Accepting new patients
Aga, LLC CurrentSince Mar 24, 2018 Accepting new patients

Locations

3400 Old Milton Pkwy
Ste 380
Alpharetta, GA 30005
Phone (678) 982-1485

1355 Peachtree St NE
Ste 1600
Atlanta, GA 30309

1505 Northside Blvd
Ste 2000
Cumming, GA 30041
Phone (770) 781-4010

2520 Windy Hill Rd SE
Ste 102
Marietta, GA 30067
Phone (770) 612-8165

488 Kennesaw Ave NW
Ste 150
Marietta, GA 30060
Phone (770) 427-3075

488 Kennesaw Ave NW
Ste 200
Marietta, GA 30060
Phone (770) 427-3075

1340 Upper Hembree Rd
Ste A
Roswell, GA 30076
Phone (770) 569-0777

5671 Peachtree Dunwoody Rd
Ste 511
Sandy Springs, GA 30342

4275 Johns Creek Pkwy
Ste A
Suwanee, GA 30024
Phone (678) 475-1606

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/d88010de-d791-42d4-b72d-513f9afc5ed1/
  • Direct secure messaging: jaewook.dong@ud.eclinicaldirectplus.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1689803652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 PEACHTREE ST NE STE 1600",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303093276",
            "telephone_number": "678-223-7774",
            "fax_number": "678-223-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4275 JOHNS CREEK PKWY STE A",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "30024",
            "telephone_number": "678-475-1606",
            "fax_number": "678-475-1615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1340 Upper Hembree Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Roswell",
            "state": "GA",
            "postal_code": "300760927",
            "country_code": "US",
            "telephone_number": "770-569-0777",
            "fax_number": "770-569-7631",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3400 Old Milton Pkwy Ste 380",
            "address_purpose": "LOCATION",
            "city": "Alpharetta",
            "state": "GA",
            "postal_code": "300053707",
            "country_code": "US",
            "telephone_number": "678-987-1485",
            "fax_number": "678-987-1486",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1505 Northside Blvd Ste 2000",
            "address_purpose": "LOCATION",
            "city": "Cumming",
            "state": "GA",
            "postal_code": "300416205",
            "country_code": "US",
            "telephone_number": "770-781-4010",
            "fax_number": "770-781-5334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONG",
        "first_name": "JAE WOOK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-10",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125055845",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "40328",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "080202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003204609M",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Suwanee, GA

Sources for this page

Verify at the official NPI Registry.